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General NPI Number Information
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NPI Number | 1801117171
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Entity Type | Individual
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Provider Name | KERRY LOUISE BUCKLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 11/15/2025
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Provider Practice Location Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5005
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Country | US
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Telephone | 904-542-7419
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Fax | 904-542-7839
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Provider Business Mailing Address
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Address Line | 236 N BRIDGE CREEK DR
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City | ST JOHNS
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State | FL
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Zip | 32259-8882
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Country | US
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Telephone | 301-537-1680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD0000048093
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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